Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse

Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse

Published: May 2000

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Background

Addiction is not often treated within the scope of routine medical practice. CASAColumbia’s national substance abuse survey is the most comprehensive nationally representative survey of how primary care physicians—family doctors, pediatricians, general practitioners, internists, obstetricians and gynecologists—deal with patients who have substance abuse problems and the experiences of such patients with their primary care physicians.

Methods

CASAColumbia surveyed a nationally representative sample of 648 primary care physicians and a patient sample of 510 adults currently receiving treatment for substance abuse in 10 facilities in California, Illinois, New York and Minnesota. The surveys were conducted in the spring and summer of 1999. To inform the survey, focus groups were conducted with primary care physicians, patients receiving substance abuse treatment and primary care support staff in the Chicago area. Key informant interviews were also conducted with physicians who had expertise in substance abuse.

Results

The vast majority (94%) of primary care physicians (excluding pediatricians) failed to diagnose substance abuse when presented with early symptoms of alcohol abuse in an adult patient

41% of pediatricians failed to diagnose illegal drug abuse when presented with a classic description of a drug-abusing teenage patient; these physicians and pediatricians failed to include substance abuse among the 5 diagnoses they were asked to suggest

Most patients said their primary care physician did nothing about their addiction

43% said their physician never diagnosed it

11% said the physician knew about their addiction but did nothing about it

Less than one-third of primary care physicians carefully screened for substance abuse

Physicians were missing or misdiagnosing patients’ substance abuse for several reasons:

Primary care physicians should screen their patients for substance abuse and be responsive to clusters of symptoms that may signal abuse of tobacco, alcohol and other drugs

Primary care physicians should be held liable for negligent failure to diagnose substance abuse and addiction and should encourage their patients to seek treatment

A Note on the Language
In 2012, CASAColumbia stopped using words like “drug abuse”/“drug abuser” because the terms have negative connotations. Instead, we now distinguish between “addiction” (clinical criteria for the disease) and “risky use” (use of addictive substances in ways that increase the risk of harm but do not meet criteria for addiction). Some reports and other publications published prior to 2012 still contain this outdated language.